Symbolic Challenges of Health-Related Philanthropy

One of the remarkable advances in 20th century medicine was the development of techniques for moving bodily fluids and organs from one body to another. This scientific advancement has challenged the symbolic meanings of body and body parts long held by Christians.

Churches are dedicated to the core ethics of “do unto others” and “stewardship of God’s provisions for life.” The focus for expressing these ethics is charitable giving of financial resources and volunteering time to charitable projects. Research consistently demonstrates that church-going people do many more such acts than non-church going people.<?xml:namespace prefix = o ns = “urn:schemas-microsoft-com:office:office” />

But medical technology now offers multiple other opportunities for philanthropy through the gift of one’s own body fluids, parts and cadaver. These gifts are life giving but surrounded by great ambiguities. Perhaps that is why congregations seldom teach about body philanthropy, and there is no evidence that religious people are more likely the non-religious to donate body parts.

The range of choices is actually quite stunning when we recall that blood transfusion was not a reliable process before World War I and kidney transplantation emerged only in the late 1950’s.

Medicine classifies these organs and tissues as biological resources:

–Renewable resources, such as blood, sperm and bone marrow. Blood donation requires only a few minutes of time and minor discomfort. There may even be minor health benefits to accrue to the donator.

Yet the symbol of salvific blood is woven into the Christian faith so that the “gift of life-saving blood” becomes a multi-faceted metaphor. What are the ethics of motivating congregants to participate in this exercise not simply as a civic duty but as a spiritual exercise?

–Resources on the margin, like a living kidney or living liver. More complex donation decisions involve those marginal resources from the living donor. Kidney and partial liver donation from living donors require substantial physical sacrifice on the part of the donor and entail some degree of long-term risk.

But these donations are most often from one relative to another, and thus carry the ethic of family love as well as human good. This ethic falls more into the category of how family members sacrifice their own well-being and resources in order to enhance the well-being of their loved ones. Seldom is the ethic of stranger love invoked.

–Resources no longer useful, like cadaver organs and tissues. The most tragically complex donation decisions are organ donations from brain-dead persons. These persons have almost always died unexpectedly through a trauma or devastating neurological event. Even if the dead person has signed a donor card, donor organizations almost always allow the grieving family to decide concerning the gift of organs. Grieving family members are the key decision-makers.

I have frequently heard the following symbolic expressions of reluctance from persons asked to consider donation:

–“He’s already suffered enough. Don’t cut on him any more” (respect for the dead).
–“I couldn’t bear the thought of her heart living in the body of a stranger. She wouldn’t really be dead” (unity of body and spirit).
–“He will need all his body someday” (belief in bodily resurrection).

These objections illustrate the ethical shift between the realm of scientific materialism (physical resources) and that of the symbolic and spiritual (love and faith). The unconscious expressions of persons in crisis exhibit core beliefs seldom addressed by either donor education or church teaching.

This move is further illustrated by considering the “who counts?” in macro-donation conversations. Several religious communities have expressed support for organ donation when focused on individuals in need. However, they qualify this support by noting the extreme costs of these procedures and follow-up care. They thus challenge the stewardship of resources from the community perspective, even though the individual experiences huge benefits.

Religious teachings focusing on human flourishing include the well-being of the entire community. That community roots its life in awareness of human finitude, contingency and limits. Human flourishing also depends upon awareness that death is not the end of one’s existence. There are fates worse than death for both individuals and communities.

Such teaching differs from scientific materialism, which focuses on extending physical life and transcending as many human limits as possible. Further, death is the ultimate failure for medicine.

How can congregations better participate in shaping persons prepared to face these choices, both the simple and the complex?

–Establish congregational health ministries with a strong teaching as well as service components.

–When donation issues are present in the local press, include conversations about the ambiguous and difficult choices that are present. These conversations are relevant in both educational and preaching settings.

–Keep diverse voices speaking. Both those who advocate for resurrection medicine procedures and those who advocate otherwise should be considered.

–Remember that balancing individual well-being and community well-being is a difficult task. The task is an opportunity for conversation, not politicizing.Steve Ivy is vice president for values, ethics, social responsibility, and pastoral services of Clarian Health Partners in Indianapolis, Ind.